PBM Accountability Project Statement on Improving Transparency into Pharmacy Benefit Manager Fee Disclosure Final Rule

The U.S. Department of Labor (DOL) today announced implementation of its final Improving Transparency into Pharmacy Benefit Manager Fee Disclosure rule, requiring PBMs to disclose direct and indirect compensation to plan fiduciaries and establishing audit rights for employers. The final rule aligns DOL regulations with statutory requirements of the Consolidated Appropriations Act of 2026, sets defined disclosure timelines, and requires that PBMs disclose to health plan sponsors their compensation from all sources in plain dollar amounts with machine-readable files available upon request.

Earlier this year, PBMA led more than 75 organizations in a sign-on letter to DOL urging finalization of this rule and calling for stronger disclosure requirements to close the loopholes PBMs have historically exploited.

Mark Blum, managing director of the PBM Accountability Project, issued the following statement:

“Today’s final rule is another important step toward a prescription drug system that works for workers and employers, not for the middlemen who profit from it. The PBM Accountability Project applauds the Department of Labor for finalizing this rule and for hearing the call from the more than 75 organizations that joined us in urging DOL to act.

“The requirements finalized today are significant and meaningful. PBMs serving large, self-insured health plans will now be required to make initial disclosures before a contract is signed, provide actual compensation data every six months, and submit to an annual audit. Critically, those disclosures must be in plain dollar amounts, which means no more hiding behind unexplained jargon or opaque metrics that obscure what PBMs are actually being paid, and by whom.

“This announcement marks yet another foundational step to rein in exploitative and anti-competitive business practices of PBMs and the major, vertically integrated insurer conglomerates that own them. The new DOL rule announced today will provide health plan fiduciaries with vital information they need to make better informed purchasing decisions, and it will require PBMs to report income derived from all sources. This is a significant advance.

“But we will remain watchful. The DOL rule announced today requires greater PBM transparency, but it falls short of prohibiting conflicts of interest that incentivize PBMs to exploit their own customers for profit by promoting higher cost prescription drugs over lower cost, therapeutically equivalent alternatives at the expense of their own customers.  Such prohibition against financial conflicts of interest are bulwarks of our system for practice of medicine, yet they remain largely absent in the governance of PBM practices in management of pharmacy benefits. Under the new DOL rule, substantially greater information will be required about PBM-negotiated drug costs, discounts and sources of income, but responsibility for prohibiting PBM conflicts of interest will rest with employer and union health plan fiduciaries. More work needs to be done to bring the full force of government to bear, as well, on prohibiting conflicts of interest that enable PBMs to derive income from practices that raise costs for their PBM customers and endanger the lives and wellbeing of patients. Such conflicts of interest in representing self-funded health plan sponsors are incompatible with a well-functioning, competitive prescription drug marketplace, and they are offensive to basic American values.

"PBMs have a well-documented history of finding workarounds when new requirements threaten their bottom line. Offshore subsidiaries and group purchasing organizations (GPOs) have become standard tools for PBMs and their affiliate insurer conglomerates to keep the true cost of their compensation hidden from the employers and workers who ultimately bear it. Vertical integration of the nation’s largest three PBMs, which have become subsidiaries of America’s largest three corporate insurer conglomerates, creates a plethora of new opportunities for PBMs to hide income and evade accountability. A rule is only as strong as its enforcement, and we will be watching enforcement of the new rule closely."